Physical Therapy Guide to De Quervain’s Tendinitis
De Quervain's (dih-kwer-VAINS) tendinitis is a painful condition. It affects the tendons on the thumb side of the wrist, near the base of the thumb and forearm. It occurs when the tendons at the wrist become irritated or restricted. The condition often is linked to repeated hand or wrist movements. These include activities such as playing tennis, gardening, cutting hair, texting, or others that require repeated grasping. De Quervain’s affects people of all ages. Women are eight to 10 times more likely to develop it than men. Cases that last a long time may need surgery.
Physical therapists help people with de Quervain’s avoid painful movements. They provide treatments to reduce pain and inflammation and prescribe exercises to improve strength and range of motion. They also educate people about the condition and recommend ways to modify activities and positions.
Physical therapists are movement experts. They improve quality of life through hands-on care, patient education, and prescribed movement. You can contact a physical therapist directly for an evaluation. To find a physical therapist in your area, visit Find a PT.
What Is De Quervain’s Tendinitis?
De Quervain's tendinitis is a common condition that involves tendons in the wrist. Tendons are tough cords or bands of tissue that attach muscles to a bone. The thumb and wrist tendons are encased in a sheath or a tunnel that keeps them in place. De Quervain's tendinitis results when the tendons become inflamed or thickened from overload or repeated use. This makes it difficult for the tendons to slide through the tunnel. The condition can occur suddenly or over a period of time. Grasping or extending the thumb (pulling it back as when giving a thumbs-up sign) causes pain.
Risk factors for developing de Quervain's tendinitis include:
- Chronic overuse of the hand.
- Female gender.
- Pregnancy and/or lifting children repeatedly.
- Doing activities that stress the hand, wrist, and/or thumb (such as texting, gaming, tennis).
- Age greater than 40 years.
- History of inflammatory disease, such as rheumatoid arthritis.
How Does It Feel?
A person who has de Quervain's tendinitis may:
- Feel tenderness, pain, and/or swelling at the wrist near the base of the thumb.
- Have trouble grasping things or pinching with the thumb.
- Feel pain when moving the wrist from side to side or twisting it.
- Have limited thumb mobility and/or a feeling of weakness.
- Notice pain, stiffness or weakness with activities, such as writing, opening jars, lifting, or hammering.
- Notice a catching or snapping feeling when moving the thumb. (This is less common.)
Note: Other conditions of the wrist and hand can cause symptoms similar to de Quervain’s. Your physical therapist will look for any related joint, tissue, or nerve problems that may be causing your symptoms.
How Is It Diagnosed?
Your physical therapist will conduct a full evaluation to determine all the factors that may contribute to your condition.
They will interview you to gather information about your health history, condition, and activities. Forms you fill out before your first session help your physical therapist gather needed information. The interview will become more specific to the symptoms of de Quervain’s. Your physical therapist may ask you questions such as:
- How and when did you first notice symptoms? What do your symptoms feel like at present?
- Do your home or work activities require repeated use of your hand and thumb?
- How have you taken care of the condition? Have you seen other health care providers? Have you had imaging or other tests and received their results?
- What are your current symptoms, and how have they changed your typical day and activities?
- Do you have pain, and if so, what is the location and intensity of your pain? Does pain vary during the day?
- Do you have trouble doing any activities? What activities are you unable to do because they make your symptoms worse? How do you reduce your symptoms?
This information allows the physical therapist to better understand what you are experiencing. It also helps determine the course of your physical exam.
The physical exam will vary depending on your interview. Most often it will begin with observing the region of your symptoms and any movements or positions that cause pain. Your physical therapist also may examine other nearby areas. The physical exam may include:
- Measuring the flexibility and range of motion of your thumb and wrist.
- Assessing the strength of your thumb muscles and grip.
- Identifying any spots that may be tender.
- Asking you to make any movements that cause your pain.
Your physical therapist also will conduct tests to rule out other conditions that may mimic de Quervain's symptoms. They likely will perform a Finkelstein test. This test gently stretches the tendons on the thumb side of the wrist to see if it causes pain.
How Can a Physical Therapist Help?
Your physical therapist will work with you to develop a treatment plan specific to your condition. They will review and evaluate how you use your hand and wrist, and may ask about your home, work, and sports activities.
Your physical therapist will note any activities or hand and arm positions that may contribute to the problem. They will instruct you on how to make changes to aid healing and reduce your risk of causing the problem in the future.
They may instruct you to avoid:
- Repeated thumb and/or wrist movements.
- Flexing your thumb (tucking or folding the thumb into the palm of the same hand).
- Rotating your wrist to move your hand in the direction of the pinkie finger as much as possible.
- Forceful hand movements and any movements or activities that increase pain.
The physical therapist may provide a wrist splint. This splint will position your wrist and thumb for rest, and provide compression to help ease pain and swelling. Your treatment program may include:
Patient education. Your physical therapist will educate you about your hand injury. They will work with you to identify and suggest changes to external factors that may contribute to your pain. These can include changing the type and number of exercises or athletic activities you do, and your daily activities. Your physical therapist will develop an exercise program specific to you, to help ensure a pain-free return to your desired activities.
Pain management. Your physical therapist will design a program to address your pain. It may include treatments such as applying ice to the affected area. They also may recommend that you change some activities that cause pain. Physical therapists are experts in pain-management methods that reduce or eliminate the need for medicines, including opioids.
Range-of-motion exercises. Limited mobility of your wrist tendons increases the stress on them. Restriction at the areas close to the hand also may force other areas to work at a disadvantage. Your physical therapist may teach you self-stretching techniques to decrease tension and help restore normal motion.
Manual therapy. Your physical therapist may treat your condition by applying hands-on treatments to gently move your muscles and joints. These techniques help improve motion. Hands-on (manual) therapy also may be used to guide the wrist region into a less stressful movement pattern. Your physical therapist may use their hands to provide resistance during certain exercises to help improve strength that may be limited by your condition.
Muscle strengthening. Muscle weaknesses or imbalances can contribute to de Quervain’s symptoms. Your physical therapist will design a safe, progressive resistance program specific to you. You may begin by performing strengthening exercises in varying positions. Your physical therapist will teach you exercises that are right for you based on your age and condition. This may include using resistance machines or elastic bands in the clinic, at home, or at a gym.
Functional training. Once your pain, strength, and motion improve, you will need to safely transition back into more demanding activities. To minimize stress on your hand and thumb, it is important to learn safe, controlled movements. Based on your movement assessment and goals, your physical therapist will create a series of activities to help you learn how to use and move your body correctly and safely.
Braces and other assistive devices. You, your physical therapist, and other health care providers will decide whether bracing your thumb is right for you. Your physical therapist may provide a wrist splint to position your wrist and thumb for rest and to provide compression to ease pain and swelling.
If you still have symptoms after physical therapy treatment and appropriate rest, a steroid injection given by a doctor can help reduce swelling and pain. If neither physical therapy or steroid injections help, and pain persists, surgery may be an option.
How Can a Physical Therapist Help Before and After Surgery?
If you need surgery, it is likely that you will have treatment by a physical therapist before surgery. You may become familiar with some physical therapy strategies. After surgery, your physical therapist will work with you to:
- Monitor wound healing.
- Provide treatments and methods to help control swelling.
- Improve and/or maintain your hand, wrist, and finger flexibility.
- Improve your range of motion.
- Rebuild strength in your hand, wrist, and entire upper extremity.
- Provide a splint to protect your hand and wrist after the procedure, if needed.
- Teach you how to safely return to the activity levels you enjoyed before your injury.
Can This Injury or Condition Be Prevented?
Can This Injury or Condition Be Prevented?
It may be possible to prevent de Quervain's tendinitis. Some risk factors cannot be controlled, such as gender or age. However, a physical therapist may recommend that you:
- Avoid chronic overuse of the hand.
- Avoid or restrict overly forceful use of the wrist.
- Avoid excessive use of the thumbs, such as with texting.
- Avoid putting the wrist and hand in awkward positions while using the hand or arm.
- Train and condition in sports, such as golf and tennis, to minimize wrist and thumb strain.
- Take frequent breaks if you must repeat an activity that aggravates your condition.
Your physical therapist can teach you correct and safe hand and wrist positions for home, work, and sport activities.
What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and experience to treat de Quervain's tendinitis. However, you may want to consider:
- A physical therapist with experience in treating people with hand conditions, sports injuries, or repetitive stress injuries of the upper limb.
- Physical therapists who have a practice with a focus on hand rehabilitation.
- A physical therapist who is a board-certified clinical specialist, or who has completed a residency or fellowship in orthopedic or hand therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to your condition.
You can find physical therapists in your area with these credentials and clinical expertise on Find a PT, a tool built by the American Physical Therapy Association.
General tips when you're looking for a physical therapist (or any other health care provider):
- Get recommendations from family, friends, or other health care providers.
- When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people who have de Quervain's tendinitis.
- Be prepared to describe your symptoms in as much detail as possible during your first visit. Make a note of what makes your symptoms better or worse.
The American Physical Therapy Association believes that consumers should have access to information to help them make informed health care decisions and prepare them for their visit with a health care provider.
The following resources offer some of the best scientific evidence related to physical therapy treatment for de Quervain’s tendinitis. They report recent research and give an overview of the standards of practice both in the United States and internationally. They link to a PubMed* abstract, which may also offer free access to the full text, or to other resources. You can read them or print out a copy to bring with you to your health care provider.
Allbrook V. The side of my wrist hurts: De Quervain's tenosynovitis. Aust J Gen Pract. 2019;48(11):753–756. Article Summary in PubMed.
Huisstede BM, Gladdines S, Randsdorp MS, Koes BW. Effectiveness of conservative, surgical, and postsurgical interventions for trigger finger, Dupuytren disease, and De Quervain disease: a systematic review. Arch Phys Med Rehabil. 2018;99(8):1635–1649.e21. Article Summary in PubMed.
Huisstede BM, Coert JH, Friden J, Hoogvliet P; European HANDGUIDE Group. Consensus on a multidisciplinary treatment guideline for deQuervain disease: results from the European HANDGUIDE study. Phys Ther. 2014;94(8):1095–1110. Article Summary in PubMed.
*PubMed is a free online resource developed by the National Center for Biotechnology Information. PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.